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Indian Pediatr 2015;52:
447 |
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News in Brief |
Gouri Rao Passi,
Email:
[email protected]
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Shorter Drug Regimen in Tuberculosis
The results of a new drug regimen trial for
tuberculosis were recently published in the Lancet. The regimen, called
PaMZ, is a three-drug regimen comprising of pretomanid (Pa), formerly
known as PA-824, moxifloxacin (M), and pyrazinamide (Z). This Phase 2b
trial, named N002, was conducted on 200 patients in South Africa and
Tanzania, and included patients with both drug sensitive and
multidrug-resistant (MDR) tuberculosis. At the end of eight weeks,
sputum culture was negative in 71% patients on PaMZ versus 38% on
standard drug regimens. It is expected that with this regimen,
drug-sensitive tuberculosis patients will require just 4 months of the
therapy, and patients with MDR tuberculosis may become disease-free by 6
months. This will be a major breakthrough in the management of both
drug-sensitive and MDR tuberculosis. Once daily dosing and absence of
injectable drugs will certainly enhance compliance for this regimen.
Close on the heels of these encouraging results, a
global Phase-3 trial named STAND (Shortening Treatment by Advancing
Novel Drugs), has commenced. In this trial, it is planned to recruit
1500 patients in 15 countries, and test the regimen for 4 months in
drug-sensitive patients, and 6 months in drug-resistant patients. The
regimen is likely to slash costs of therapy in MDR tuberculosis by 90%,
and is also compatible with commonly used antiretroviral drugs. (Lancet.
2015 Mar 17. pii: S0140-6736(14)62002-X. doi:
10.1016/S0140-6736(14)62002-X.)
Monitoring Artemisinin Resistance
Mutations in the K13 gene are the major
determinants of P. falciparum artemisinin resistance. This
discovery followed very quickly after artemisinin resistance was first
noted in Cambodia. This affords a real possibility of mapping and
monitoring spread of resistance, unlike what happened with older
antimalarials. For instance, chloroquine, sulfadoxine and pyremethamine
resistance was already rampant in Africa by the time their molecular
markers (Pfcrt, Pfdhfr, and Pfdhps) were discovered. Researchers from
Myanmar have documented a detailed molecular study of K13 from P
falciparum field isolates obtained from symptomatic patients at more
than 50 different sites in the country during 2013-14. Their countrywide
collection of samples is associated with a predictive, fine-scale (5 × 5
km) geospatial representation of the prevalence of K13 mutants. This
data can be used to predict mutants in unsampled populations in and
around the area. The molecular data provide strong evidence that
artemisinin-resistant falciparum malaria in Myanmar extends across much
of Upper Myanmar, including areas close to the Indian border in the
northwest. This enables national programs to obtain clear and useful
information about the extent of resistance, and thus implement
appropriate actions. Real-time detection and monitoring of the
geospatial distribution of antimalarial drug-resistant parasites is now
a possibility, as is prevention of their dissemination in neighboring
endemic areas. (Lancet Infect Dis. 2015;15:415-21. doi:
10.1016/S1473-3099(15)70032-0)
The 5 Keys to Safer Food
Food production is now industrialized. Errors in
packaging and distribution can have global footprints. This year’s World
Health Day on 7th April is being dedicated to food safety. The WHO has
released a simple checklist called the 5 steps to food safety: (i)
keep clean; (ii) separate raw and cooked; (iii) cook
thoroughly; (iv) keep food at safe temperatures; and (v)
use safe water and raw materials. By these simple messages, the WHO
hopes to curb the 200 odd diseases spread by contaminated food which
kill more than 1.8 million people around the world. The WHO has released
a manual for training of food handlers, home makers, school children and
others who are involved in the food production chain. Many simple and
pertinent points are discussed such as hand washing, cleaning cooking
surfaces and pest control. They suggest that it must be ensured that
food reaches at least 70 degrees during heating. Cooked food should not
be left at room temperature for more than 2 hours or in the fridge for
more than 3 days. Leftovers should not be reheated more than once. (http://www.who.int/foodsafety/areas_work/food-hygiene/5keys/en/)
Guidelines for Chronic Hepatitis B
The WHO has released its first guidelines for the
management of patients with chronic hepatitis B infection. The evidence
of cirrhosis may be determined based on simple non invasive tests such
as the APRi (aspartate aminotransferase-to-platelet ratio index) and
FIB4 index (based on age, aspartate aminotransferase and alanine
aminotransferase levels, and platelet counts). Transient elastography or
the Fibroscan may be used where cost is not a concern. It is recommended
that all adults and children with chronic hepatitis B infection with
cirrhosis must be treated regardless of HBeAg status, ALT levels or HBV
DNA. For children aged between 2-11 years, entecavir is recommended.
Monitoring and discontinuation protocols are also clearly outlined. (http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf?ua=1&
ua=1)
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